X-ray came back negative after hit to nose but bone bump has formed. Do I need second opinion re: x-ray or is this common?

Question

I was elbowed on the bridge of my nose and suffered a cut. The initial exam by a doctor indicated there was no fracture which an x-ray confirmed a week later. It's now been almost 3 weeks and while the swelling has gone down and the cut pretty much healed, I'm left with a rather obvious bump on the bridge of my nose. Should I be concerned that the x-ray and exam are wrong? Is it possible to have a bump form on the bone without a break or fracture? Please advise next steps. Thanks, Zach

Gerald Minniti, MD, FACS · Answer

Hello,There is no information an X-ray can provide that would alter the course of action based on physical exam.  In other words, its all about how it looks, not whether a bone is fractured.  Having said that, after a few weeks, if this bump is determined to be a displaced bone by an expert, and you would like it fixed, you will need a procedure to re-align it.  Unfortunately, it cannot always be done in a closed fashion, and may require an open procedure to release bones or even make new cuts into bone to achieve a desired result. Best of luck!

Elbert T. Cheng, MD · Answer

Hello Zach,I think what you are seeing at this point is residual swelling that is left after the nasal injury.  If the x-rays didn't reveal a fracture, but there is a subtle hairline fracture, you may have bony formation over the region at this stage.  This usually appears 4-8 weeks after the injury.  At this point, try to be patient with the healing process and let the swelling resolve.  I would wait 3-6 months (if you can tolerate it) and if it still bothers you, seek a rhinoplasty surgery for an expert opinion and an in-office exam.  Best of luck!

William Portuese, MD · Answer

Trauma to the nose can cause a displaced nasal fracture for which surgery is usually performed to reset the nasal bones. Trauma to the nose can also cause a non-displaced fracture which is usually left alone. In addition, trauma can also cause a  dislocation of the upper lateral cartilage off of the nasal bones which creates a depression in the midportion of the nose. A deviated septum can also result for fracture of the nasal septum for which a septoplasty is required. It's best to wait a few months to see if the dorsal hump resolves on its own, but if not then surgery may be needed to reduce it. For many examples, please see the link and the video below

Mohsen Tavoussi, MD, DO · Answer

It will take several months for complete healing after trauma but regardless of x-ray result, if you have bump you have a bump. But it may not be a permanent one.

Jeremy B. White, MD · Answer

Yes, you can get a bump that still feels firm for a few weeks that is related to swelling of the skin and soft tissue of the nose. This can also occur if there was a bleed in the area that caused a hematoma and related to a fracture. Physical exam is often more helpful than an xray when determining the clinical significance of a nasal fracture. At this point of 3 weeks after the injury, you are past the 7-10 day window of closed reduction for a nasal fracture even if you had one. It is best to wait for swelling to go down and then followup with a plastic surgeon in the future if it does not resolve.

Michael Elam, MD (retired) · Answer

Dear zgoode, In the next few months as the swelling dissipates and you recover you will be able to determine if you need surgical intervention to take care of the bump. Trauma to the nose can cause a bump from bleeding, swelling, dislocation of the upper lateral cartilages, or deviation of the septum. An intra-nasal examination will be able to determine a proper diagnosis. Best regards, Michael V. Elam, M.D.

Jon A. Perlman, MD (retired) · Answer

A new nasal bump can be due to temporary swelling, scar tissue formation as a result of bleeding, nasal fracture or cartilage displacement.  Some bumps disappear and others persist.  I'd suggest that you see a nose surgeon to discuss possible taping or other treatments at this early stage.  Otherwise, you'll need to wait a few months to see whether it disappears or whether you need to have a procedure to fix the area.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic
Surgery (ASAPS)
Beverly Hills, California

Richard W. Fleming, MD (retired) · Answer

I rely on examination more than x-ray results following nasal trauma. I suggest you schedule an examination by a rhinoplasty surgeon to evaluate the "bump" which may or may not be temporary.

X-ray came back negative after hit to nose but bone bump has formed. Do I need second opinion re: x-ray or is this common?

Answers (8)

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